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Thursday, May 7, 2015

Mental Health Issues Are Hard

T.S.S. is a man in his mid-30s. He lives in Rutland. He has a form of schizophrenia that causes him to have delusions and that can cause deterioration in his functioning. For the last fifteen years or so, he’s worked with doctors and case managers, and has taken medication. Off and on since 2000 he was ordered by various courts to take medication..

Here’s what we know. T.S.S. started showing symptoms of schizophrenia in 1999, and started to show signs of hurting himself. He went to the Vermont State Hospital, and was released in 2000 on an order of non-hospitalization (ONH). T.S.S. did well on the ONH. The State wanted the ONH continued and so filed in court to extend it. That request was denied. T.S.S. is a talented musician, and went to California to be a drummer in a band for a while. He came back to Vermont in 2003 and started having delusions again. This time, the delusions could have been harmful to him, as he believed people were poisoning his food. He was hospitalized again, and later released on another ONH, which was continued by the court for an additional year. He was under an ONH until 2008, when his service providers decided not to ask to continue it. From 2008–2012 T.S.S. doesn’t seem to have gotten any services, but nobody heard a peep from him, either.

In 2012, T.S.S. got charged with misdemeanor-level unlawful mischief, which is a property crime and is non-violent. He was found by the criminal court to be incompetent to stand trial. His charge was dismissed in exchange for being placed on another ONH. When that order expired the State filed an application for continued treatment, which was granted. The State filed again in 2014, which was granted after a hearing, and which is the subject of the appeal here.

T.S.S.’s psychiatrist and case manager testified at the hearing. The psychiatrist said that when T.S.S. is under an order he engages in treatment and he does well. But when there is no order, he often stops taking medication, and if he did that, his condition would deteriorate. She couldn’t say exactly when that would happen, but thought that could happen over the course of six to twelve months. She also said that T.S.S. didn’t like his medication’s side effects (I presume this fact was included to indicate that he might stop taking his medicine because he didn’t like the side effects). She testified that he expressed a desire to go to France sometime when the order had lapsed, which she thought was unrealistic because he has limited resources. She also said that her staff saw him riding his bike in the middle of the street, but had to concede it was during times when there wasn’t a lot of traffic.

The trial court concluded based on the testimony that the order should continue. Under the applicable statute, the court had to find that T.S.S.’s condition would deteriorate in the near future and that when that happened he would become a “person in need of treatment.” A “person in need of treatment” is a specific term meaning that the person has a mental illness and as a result of it could be a danger to himself or others (the actual definition in the statute is much longer, but this boiling-down does the trick for here).

T.S.S. appealed.

SCOV starts by taking a look at the statute. This is a de novo review, since it’s a review of statutory interpretation. SCOV finds that the way the statute is written, that a trial court has to be able to find by clear and convincing evidence that if treatment is discontinued that the person’s condition will deteriorate in the near future and that in the near future the person will become a person in need of treatment. SCOV reminds us that when a statute says “and” that it means both parts apply.

It’s not enough to say that someone’s condition might deteriorate without treatment. The point of the statute is not simply to treat people with mental health issues. The point of the statute is to treat people with mental health issues who, as a result of the issues are a danger to themselves or others.

There wasn’t any evidence in this case that T.S.S. was going to become a danger to himself or anyone else if the treatment was stopped. There was some evidence that a dozen or so years before he had some delusions about his food, but there wasn’t any evidence that that ever happened again. There wasn’t a whole lot of evidence about how he did from 2004-2012, and there really wasn’t any evidence to show how he was doing during the 2008-2012 span when he wasn’t under any kind of court order to engage in treatment. Could he have benefitted from treatment during that time? Maybe, but since there wasn’t any evidence either way, nobody knows.

The other part is that he was under an ONH as a result of a misdemeanor property crime. Nobody was hurt, and there’s no conclusion that he was a danger as a result of the offense.

After reading the plain meaning of the statute, SCOV also dove deep into the legislative history of the mental health laws. SCOV found that when the mental health laws were passed back in the 1970s, that there was legislative testimony about what the phrase “near future” meant, and to what it applied. SCOV found persuasive that the law was meant to target not just deterioration in the near future, but also someone becoming dangerous in the near future. SCOV is pretty clear that it’s not resting its decision on legislative history, but points out that its interpretation is consistent with the goals of the law as envisioned at the time of passage.

Finally, SCOV has some constitutional concerns. People have the right to travel and move around and to be left alone. Due process applies to everybody. The possibility of deterioration isn’t enough for a commitment order.

So, based on the evidence, and based on the construction of the statute and what the statute’s goal is, SCOV vacates the order of non-hospitalization. SCOV recognizes though that mental health issues are really tough, and that generally, people really try to do the right thing. Clinicians want their patients to be successful and healthy and don’t want to see any deterioration. That’s just not enough for a court order, though.

Justice Eaton wrote a concurrence, which Chief Justice Reiber joined. Justice Eaton felt that the statutory construction analysis was enough in this case, and that it wasn’t really necessary to get into the legislative history. That’s really saved for rare situations where the legislative intent isn’t clear from the face of the statute. He’s also concerned about giving too much weight to testimony given by witnesses at legislative hearings, since it’s hard to know what impact, if any, that testimony had on the legislation ultimately passing.